Resident Hazard Pay?

[<L>]

So this thread has been blowing up today from an NYU resident and I'm kind of mixed about it.



1. Yeah, working in NYC has to be straight up awful right now
2. Hospital system revenue is down as much as 50% or more right now depending on where you're at and support staff who are making even less than the residents are losing their jobs. Despite the risks, residents still have stable employment
3. Of all the professions in the hospital who need a financial boost, I'm not sure it's the ones who are only a few years away from making a quarter mil a year for the rest of their working lives.

It's been a while since I've logged into SDN and was legit surprised not to see a thread on it, so wondering what the consensus in here is.

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[ThoracicGuy]

So this thread has been blowing up today from an NYU resident and I'm kind of mixed about it.



1. Yeah, working in NYC has to be straight up awful right now
2. Hospital system revenue is down as much as 50% or more right now depending on where you're at and support staff who are making even less than the residents are losing their jobs. Despite the risks, residents still have stable employment
3. Of all the professions in the hospital who need a financial boost, I'm not sure it's the ones who are only a few years away from making a quarter mil a year for the rest of their working lives.

It's been a while since I've logged into SDN and was legit surprised not to see a thread on it, so wondering what the consensus in here is.

SSDD.

Residents are always going to complain about being underpaid. Always.

 

[Gregor Samsa]

SSDD.

Residents are always going to complain about being underpaid. Always.

Can't imagine why.

 

[ThoracicGuy]

Can't imagine why.

I was a resident too. I know what it was like. I also know that my earning potential now is much, much higher now.

 

[Gregor Samsa]

I was a resident too. I know what it was like. I also know that my earning potential now is much, much higher now.

Absolutely, but the increase in salary over the past few years has not been commensurate with the increase in student debt (undergraduate + med school). Also, more students are having to take gap years before starting medical school, so the future earning potential is becoming more and more diminished. I can see why an NYC resident with a family to support would feel undercompensated given the amount of work and debt that is required to enter the profession.

 

[ThoracicGuy]

Absolutely, but the increase in salary over the past few years has not been commensurate with the increase in student debt (undergraduate + med school). Also, more students are having to take gap years before starting medical school, so the future earning potential is becoming more and more diminished. I can see why an NYC resident with a family to support would feel undercompensated given the amount of work and debt that is required to enter the profession.

1. Residency programs don't need to be worried about someone with gap years before their medical school. Irrelevant to the salary offered.
2. Residency programs aren't responsible for your debt you amassed in undergrad or med school.
3. NYC is an expensive place to live. You know the salary going in. If you think it is too low, go somewhere else for training.
4. When you finish your training and get an attending job you'll probably get at least 3 times your resident salary and possibly much more than that. Where you choose to work can affect this as well. You can certainly work towards paying your debt at that time.
5. The salaries offered are often at or above the average salary for a US family of 4. You aren't going to be collecting welfare.

 

[deleted814217]

I mean the point is more hazard pay in the face of a pandemic, again you were not a resident during a pandemic so not sure how this whole “paid my dues” argument holds any merit.

 

[Gregor Samsa]

1. Residency programs don't need to be worried about someone with gap years before their medical school. Irrelevant to the salary offered.
2. Residency programs aren't responsible for your debt you amassed in undergrad or med school.
3. NYC is an expensive place to live. You know the salary going in. If you think it is too low, go somewhere else for training.
4. When you finish your training and get an attending job you'll probably get at least 3 times your resident salary and possibly much more than that. Where you choose to work can affect this as well. You can certainly work towards paying your debt at that time.
5. The salaries offered are often at or above the average salary for a US family of 4. You aren't going to be collecting welfare.

Might be irrelevant to the salary that is offered, but those facts are very much relevant to the salary that is demanded. The fundamental discord here is that you are adopting the perspective of the employer rather than the employee. Your solution seems to be that nobody address any of these trends until becoming a physician becomes such a financially irresponsible decision that people pick other career pathways instead. It is already making more sense to be a PA than an MD. On the other hand, people in NYC and other big cities still need physicians, so I'm not sure if "just don't be docz in NYC lol" is a great position. The fact that people know the terms going in doesn't mean they shouldn't do anything to change them. I don't see how that follows. Not to mention how those terms have changed for the worse during the COVID-19 pandemic with widespread layoffs. Thank God Boomer docs weren't labor leaders during the industrial revolution, workers would never have eight-hour days.

 

[ThoracicGuy]

I mean the point is more hazard pay in the face of a pandemic, again you were not a resident during a pandemic so not sure how this whole “paid my dues” argument holds any merit.

I'm an attending in the face of a pandemic. I'm likely to see a salary CUT due to decreased volumes/surgeries related to this. I am NOT getting hazard pay even though I still have chances of coming in contact with positive patients on a regular basis.

So, no, I don't have much sympathy for residents complaining about their salary or hazard pay. Everyone is being affected here.

 

[Helpful Troll]

I mean the point is more hazard pay in the face of a pandemic, again you were not a resident during a pandemic so not sure how this whole “paid my dues” argument holds any merit.

Do you know what Soldiers and Airmen get for Hazardous Duty Pay or Imminent Danger Pay?

Hazardous Duty Pay - $150 per month
or
Hostel Fire/Imminent Danger Pay - Max $225 per month - $7.50 per duty day

 

[ThoracicGuy]

Might be irrelevant to the salary that is offered, but those facts are very much relevant to the salary that is demanded. The fundamental discord here is that you are adopting the perspective of the employer rather than the employee. Your solution seems to be that nobody address any of these trends until becoming a physician becomes such a financially irresponsible decision that people pick other career pathways instead. It is already making more sense to be a PA than an MD. On the other hand, people in NYC and other big cities still need physicians, so I'm not sure if "just don't be docz in NYC lol" is a great position. The fact that people know the terms going in doesn't mean they shouldn't do anything to change them. I don't see how that follows. Not to mention how those terms have changed for the worse during the COVID-19 pandemic with widespread layoffs. Thank God Boomer docs weren't labor leaders during the industrial revolution, workers would never have eight-hour days.

Did you go into medicine to get rich? Because there are other fields that can make you more wealthy sooner.

If it makes more sense to you to become a PA instead of a MD, go for it. No one is stopping you. Now a surgical specialist is going to earn significantly more than a PA, so the PA loses on earnings long term. A FP doc vs a specialized PA may be a different story.

As for not being a doctor in NYC, attendings are different than residents, though attending salaries in NYC are typically lower than many other places in the country, particularly compared to cost of living. No one says you can't become an attending in NYC if you so wish if you are a resident somewhere else.

Residency is a short, finite length of time. Your earning potential goes way up after you finish. Make it through on a salary that is equal or better to the average salary of a family of 4 and you'll be good.

You just lost the argument when you say "Boomer docs"...

 

[VA Hopeful Dr]

You just lost the argument when you say "Boomer docs"...

Jesus H, this nonsense again?

I'm not even 40 yet and if memory serves you aren't either.

 

[ThoracicGuy]

Jesus H, this nonsense again?

I'm not even 40 yet and if memory serves you aren't either.

Just over... Now get off my lawn!

 

[VA Hopeful Dr]

Just over... Now get off my lawn!

old-man-yells-at-cloud.gif

 

[yeasports]

Absolutely, but the increase in salary over the past few years has not been commensurate with the increase in student debt (undergraduate + med school). Also, more students are having to take gap years before starting medical school, so the future earning potential is becoming more and more diminished. I can see why an NYC resident with a family to support would feel undercompensated given the amount of work and debt that is required to enter the profession.

What do you propose?

 

[AMEHigh]

I'm an attending in the face of a pandemic. I'm likely to see a salary CUT due to decreased volumes/surgeries related to this. I am NOT getting hazard pay even though I still have chances of coming in contact with positive patients on a regular basis.

So, no, I don't have much sympathy for residents complaining about their salary or hazard pay. Everyone is being affected here.

I have a different perspective.
Our residents are getting extra pay for the work theyre doing.
At the same time our large outpatient practice has furloughed part-time doctors and my pay will be cut if I don’t meet certain productivity, which is not what I signed up for when I started this job.
It certainly sucks for us attendings, but it doesn’t take away my sympathy for the residents working in-patient in very difficult circumstances. I’m glad they’re getting a little bit of extra pay.
Everyone’s situation sucks, doesn’t mean just because your situation sucks you can’t have empathy for others.

To be honest the mental health toll and even physical toll this is taking and is going to have long lasting effects on both medical professionals and patients is heartbreaking. The money can help with basic necessities to get through it. I don’t think anyone has faced patient after patient dying alone/being critically ill and difficult family conversations to this magnitude. It’s ok to have a little sympathy.

ETA: if you’re working 80 hours a week taking care of lots sick patients and they’re threatening to cut your salary then I do believe that’s really messed up. However, that still doesn’t mean you can’t have sympathy for others. You need to take that up with your employer and not crap on residents.

 

[VA Hopeful Dr]

I have a different perspective.
Our residents are getting extra pay for the work theyre doing.
At the same time our large outpatient practice has furloughed part-time doctors and my pay will be cut if I don’t meet certain productivity, which is not what I signed up for when I started this job.
It certainly sucks for us attendings, but it doesn’t take away my sympathy for the residents working in-patient in very difficult circumstances. I’m glad they’re getting a little bit of extra pay.
Everyone’s situation sucks, doesn’t mean just because your situation sucks you can’t have empathy for others.

To be honest the mental health toll and even physical toll this is taking and is going to have long lasting effects on both medical professionals and patients is heartbreaking. The money can help with basic necessities to get through it. I don’t think anyone has faced patient after patient dying alone/being critically ill and difficult family conversations to this magnitude. It’s ok to have a little sympathy.

ETA: if you’re working 80 hours a week taking care of lots sick patients and they’re threatening to cut your salary then I do believe that’s really messed up. However, that still doesn’t mean you can’t have sympathy for others. You need to take that help with your employer and not crap on residents.

Are the intensivists managing all these COVID patient in the ICU getting hazard pay?

What about the ED doctors whose departments are full of COVID patients as well?

I have no objection to residents getting a bonus for this, in fact that's a very nice thing to do. What I can't say I like is residents asking for more money and then getting pissy when they're told no. I'm always on board with asking for more money, but if you're told no then accept it and go back to work (or quit if it means that much to you).

 

[<L>]

Are the intensivists managing all these COVID patient in the ICU getting hazard pay?

What about the ED doctors whose departments are full of COVID patients as well?

I have no objection to residents getting a bonus for this, in fact that's a very nice thing to do. What I can't say I like is residents asking for more money and then getting pissy when they're told no. I'm always on board with asking for more money, but if you're told no then accept it and go back to work (or quit if it means that much to you).

This is where I'm at as a Millennial attending. Maybe it's my perspective from having trained somewhere where the institution was always teetering on the financial precipice, but I found her entire thread ridiculous. Like, if your institution can swing hazard pay, cool. If it can't then throwing cash at you isn't going to magically fix the trauma of what you're doing. I clicked on it expecting a whole range of workplace abuses, but nope, it was just the usual SDN/Reddit thread about resident compensation broadcast to an audience of 23,000 followers.

Truth be told, I'm getting some serious Eugene Gu vibes from it all, particularly the thousand "OMG you're so brave for speaking out!" responses that she's been getting. Like seriously, you're a PG3 resident who's graduating in six weeks with a fellowship at another institution. No one cares that you're complaining about your pay online unless you start crossing lines to the point that your higher ups are getting harassment. And even then, NYU will probably just shrug and say "she's someone else's problem in July".

 

[ThoracicGuy]

I have a different perspective.
Our residents are getting extra pay for the work theyre doing.
At the same time our large outpatient practice has furloughed part-time doctors and my pay will be cut if I don’t meet certain productivity, which is not what I signed up for when I started this job.
It certainly sucks for us attendings, but it doesn’t take away my sympathy for the residents working in-patient in very difficult circumstances. I’m glad they’re getting a little bit of extra pay.
Everyone’s situation sucks, doesn’t mean just because your situation sucks you can’t have empathy for others.

To be honest the mental health toll and even physical toll this is taking and is going to have long lasting effects on both medical professionals and patients is heartbreaking. The money can help with basic necessities to get through it. I don’t think anyone has faced patient after patient dying alone/being critically ill and difficult family conversations to this magnitude. It’s ok to have a little sympathy.

ETA: if you’re working 80 hours a week taking care of lots sick patients and they’re threatening to cut your salary then I do believe that’s really messed up. However, that still doesn’t mean you can’t have sympathy for others. You need to take that up with your employer and not crap on residents.

Asking for more money is fine, but it's not a right. Many hospitals are hurting from a financial perspective. How can they be asked to pay residents more when they are laying off employees because volumes are otherwise down for the income generating patients?

Residents have to be realistic about things and not expect to have things handed to them...

 

[AMEHigh]

Are the intensivists managing all these COVID patient in the ICU getting hazard pay?

What about the ED doctors whose departments are full of COVID patients as well?

I have no objection to residents getting a bonus for this, in fact that's a very nice thing to do. What I can't say I like is residents asking for more money and then getting pissy when they're told no. I'm always on board with asking for more money, but if you're told no then accept it and go back to work (or quit if it means that much to you).

As far as I know attendings aren't getting extra pay. I do know that some are picking up extra shifts due to colleagues getting sick/more need, so they're getting paid more because of that.

I think there's a big difference between an attending making $250,000 a year for example and a resident making $65,000 while suddenly being pulled from all rotations and expected to work 90 hours a week.

I don't know the person who made the tweet, but our residents have been very reasonable. They asked for adequate PPE and a slight increase in pay. With the new schedules childcare costs have increased, food prices have increased, some people don't feel comfortable riding the subway so taking taxi/lyft rides so transport costs have increased. On a $250,000 salary it is a little bit easier to absorb that burden.

Us attendings have 100% supported them in asking for that and thankfully the hospital was able to accommodate a small temporary increase in pay. My only point was I can certainly have sympathy for them even though my pay is likely going down.

 

[AMEHigh]

Asking for more money is fine, but it's not a right. Many hospitals are hurting from a financial perspective. How can they be asked to pay residents more when they are laying off employees because volumes are otherwise down for the income generating patients?

Residents have to be realistic about things and not expect to have things handed to them...

I personally don't think being pulled from all your rotations and being expected to work 90 hours a week is expecting things to be handed to you.
But I think we'll have to agree to disagree.
I'm glad my program is being empathetic and supportive of our residents even while our outpatient salaries are likely going to go down (we're obviously paid from a separate pot of money).

 

[deleted814217]

I'm an attending in the face of a pandemic. I'm likely to see a salary CUT due to decreased volumes/surgeries related to this. I am NOT getting hazard pay even though I still have chances of coming in contact with positive patients on a regular basis.

So, no, I don't have much sympathy for residents complaining about their salary or hazard pay. Everyone is being affected here.

Oh I'm so sorry do attending make more than residents here? Last I checked they did but maybe things have changed. Yet again, many specialties including mine come into contact with COVID patients regularly and there are several resident run services for COVID patients.

Your argument doesn't take into account this inherent pay difference, your salary could be cut by 50% and easily still be more than a residents salary. I also have zero sympathy for your salary being cut as well. Yet again, your residency was not in the face of a pandemic, so your argument regarding residents complaining blah blah, has zero merit.

 

[90sportsfan]

Unless I'm missing the point here, isn't the crux of the resident's tweet really about hazard pay due to the risks and dangers about working on the front-line during a pandemic? Not necessarily the additional hours (although that is certainly a consideration), but moreso the risks and dangers related to COVID19 in a city at the epicenter of cases?

I think it's a valid question, although administratively, it will likely be challenging. The hospital will be strapped for money, so it could be provided on a Federal level, but then it seems like many other residency programs/hospitals would request it too (and which residents would get it? all certain primary care specialties working with higher volumes of COVID patients?). It seems like it could get complicated, but I do think it's an issue to at least bring up for discussion.

 

[<L>]

I personally don't think being pulled from all your rotations and being expected to work 90 hours a week is expecting things to be handed to you.
But I think we'll have to agree to disagree.
I'm glad my program is being empathetic and supportive of our residents even while our outpatient salaries are likely going to go down (we're obviously paid from a separate pot of money).

Now I do worry about specialists/fellows getting pulled to COVID units and how this is going to affect their education time, but in truth I haven't heard what programs are planning to do should this need extend for a long period of time...particularly if we hit a second wave next winter and it starts affecting graduation requirements. And yeah, fellows, particularly IM subspecialty fellows, are getting financially shafted by this if they get pulled into general/COVID coverage beyond the spring. I have empathy for anyone caught in this, but at the same time I worry about the financial health of a lot of institutions. Not every hospital has the money to give out.

Someone replying to her thread suggested that programs should provide own-speciality disability coverage beyond the crap coverage that we usually get. Not sure how cost-reasonable that would be, but it would seem like a better use of $ for peace of mind than just tossing a bonus check to the residents.

 

[GoSpursGo]

As always, I think you have to keep perspective that this is a zero-sum game for institutions. My current institution sent an email in the last week that the financial shortfall in the next two fiscal years is estimated to be in the hundreds of millions of dollars. Despite stopping retirement fund contributions, salary reductions for university leadership, and a hiring freeze, they basically said to expect some furloughs and layoffs to be necessary at all levels. And this is at one of the top ~20 medical institutions in the country.

None of that makes anything that residents and fellows are going through fair, and sure everyone deserves something in return for their efforts. But the honest reality is that if someone decides to give you hazard pay, that may mean some administrative person gets furloughed or let go down the line.. That money has to come from somewhere.

 

[AMEHigh]

Now I do worry about specialists/fellows getting pulled to COVID units and how this is going to affect their education time, but in truth I haven't heard what programs are planning to do should this need extend for a long period of time...particularly if we hit a second wave next winter and it starts affecting graduation requirements. And yeah, fellows, particularly IM subspecialty fellows, are getting financially shafted by this if they get pulled into general/COVID coverage beyond the spring. I have empathy for anyone caught in this, but at the same time I worry about the financial health of a lot of institutions. Not every hospital has the money to give out.

Someone replying to her thread suggested that programs should provide own-speciality disability coverage beyond the crap coverage that we usually get. Not sure how cost-reasonable that would be, but it would seem like a better use of $ for peace of mind than just tossing a bonus check to the residents.

It's not even just specialists/fellows getting pulled. Here it is everyone getting pulled.
IM and FM and peds residents although not "specialists" still expected to have their rotations that enhance their education that they are no longer getting. I know for my speciality all requirements have been relaxed and our program director clarified that of course everyone will graduate on time in June although they might not meet their expected numbers at this point due to being pulled for covid care inpatient. I completely understand that we're all adjusting and things suck, but just wanted to point that out. I agree with everything else you said.

 

[slowthai]

None of that makes anything that residents and fellows are going through fair, and sure everyone deserves something in return for their efforts. But the honest reality is that if someone decides to give you hazard pay, that may mean some administrative person gets furloughed or let go down the line.. That money has to come from somewhere.

As they totally should. I mean, why is it that the people that actually take care of patients (attendings) are getting paycuts but the nonessential personnel - administrators - are sitting pretty? It doesn't follow at all.

 

[VA Hopeful Dr]

As far as I know attendings aren't getting extra pay. I do know that some are picking up extra shifts due to colleagues getting sick/more need, so they're getting paid more because of that.

I think there's a big difference between an attending making $250,000 a year for example and a resident making $65,000 while suddenly being pulled from all rotations and expected to work 90 hours a week.

I don't know the person who made the tweet, but our residents have been very reasonable. They asked for adequate PPE and a slight increase in pay. With the new schedules childcare costs have increased, food prices have increased, some people don't feel comfortable riding the subway so taking taxi/lyft rides so transport costs have increased. On a $250,000 salary it is a little bit easier to absorb that burden.

Us attendings have 100% supported them in asking for that and thankfully the hospital was able to accommodate a small temporary increase in pay. My only point was I can certainly have sympathy for them even though my pay is likely going down.

Fine.

Are the janitors getting hazard pay? The food service people? Maintenance?

 

[<L>]

It's not even just specialists/fellows getting pulled. Here it is everyone getting pulled.
IM and FM and peds residents although not "specialists" still expected to have their rotations that enhance their education that they are no longer getting. I know for my speciality all requirements have been relaxed and our program director clarified that of course everyone will graduate on time in June although they might not meet their expected numbers at this point due to being pulled for covid care inpatient. I completely understand that we're all adjusting and things suck, but just wanted to point that out. I agree with everything else you said.

I'm triaging my empathy here. At least IM/FM residents are doing something that resembles medicine. If you're a senior surgical resident who's losing out on case numbers, that's got to sting even more. For IM subspecialty fellows, getting pulled to work general IM floors at PG4-6 pay rates when you're otherwise BE/BC has to result in some mild moral injury. Financially they'll all be fine, but ouch.

As they totally should. I mean, why is it that the people that actually take care of patients (attendings) are getting paycuts but the nonessential personnel - administrators - are sitting pretty? It doesn't follow at all.

People who keep saying this (like the ridiculous reddit thread on this topic) act like the only nonclinical staff in the hospital are MBA-having admins who are pulling down ridiculous salaries. The scheduling clerks they interact with every day making 35k/year don't exist to them.

 

[GoSpursGo]

As they totally should. I mean, why is it that the people that actually take care of patients (attendings) are getting paycuts but the nonessential personnel - administrators - are sitting pretty? It doesn't follow at all.

I'm not sure if you understood that I meant "admin" in the sense of basically any non-clinical staff member, not "administrators" like deans/presidents/etc.

If you really think that the receptionist/research nurse/lab tech who makes $30-40k should get furloughed so you can make some hazard pay... I don't really even know what to say to that.

 

[ThoracicGuy]

Oh I'm so sorry do attending make more than residents here? Last I checked they did but maybe things have changed. Yet again, many specialties including mine come into contact with COVID patients regularly and there are several resident run services for COVID patients.

Your argument doesn't take into account this inherent pay difference, your salary could be cut by 50% and easily still be more than a residents salary. I also have zero sympathy for your salary being cut as well. Yet again, your residency was not in the face of a pandemic, so your argument regarding residents complaining blah blah, has zero merit.

 

[slowthai]

People who keep saying this (like the ridiculous reddit thread on this topic) act like the only nonclinical staff in the hospital are MBA-having admins who are pulling down ridiculous salaries. The scheduling clerks they interact with every day making 35k/year don't exist to them.

I'm not sure if you understood that I meant "admin" in the sense of basically any non-clinical staff member, not "administrators" like deans/presidents/etc.

If you really think that the receptionist/research nurse/lab tech who makes $30-40k should get furloughed so you can make some hazard pay... I don't really even know what to say to that.

I assumed everyone knew I was talking about the ones making ridiculous salaries doing nothing. That's why I specifically said "sitting pretty".

Edit: But I didn't know that's what you meant, @GoSpursGo. Of course, they shouldn't take paycuts or lose their jobs just for hazard pay. But if anyone should be fired or take paycuts, it should be the ones in the c-suite, not physicians.

 

[Mass Effect]

I have a different perspective.
Our residents are getting extra pay for the work theyre doing.
At the same time our large outpatient practice has furloughed part-time doctors and my pay will be cut if I don’t meet certain productivity, which is not what I signed up for when I started this job.
It certainly sucks for us attendings, but it doesn’t take away my sympathy for the residents working in-patient in very difficult circumstances. I’m glad they’re getting a little bit of extra pay.
Everyone’s situation sucks, doesn’t mean just because your situation sucks you can’t have empathy for others.

To be honest the mental health toll and even physical toll this is taking and is going to have long lasting effects on both medical professionals and patients is heartbreaking. The money can help with basic necessities to get through it. I don’t think anyone has faced patient after patient dying alone/being critically ill and difficult family conversations to this magnitude. It’s ok to have a little sympathy.

ETA: if you’re working 80 hours a week taking care of lots sick patients and they’re threatening to cut your salary then I do believe that’s really messed up. However, that still doesn’t mean you can’t have sympathy for others. You need to take that up with your employer and not crap on residents.

Not to mention as attendings, we can walk away and likely have substantial savings and a career to come back to when this is over (even if at a different place), and those of us in certain fields can just hang our shingle. Residents don't have that choice. They do what they're told and they're told to care for a critically ill population day after day after day after working long shifts, sometimes without PPE, and being emotionally drained and traumatized by what's happening. They don't get to walk away unless they leave the field of medicine altogether.

 

[<L>]

I assumed everyone knew I was talking about the ones making ridiculous salaries doing nothing. That's why I specifically said "sitting pretty".

Edit: But I didn't know that's what you meant, @GoSpursGo. Of course, they shouldn't take paycuts or lose their jobs just for hazard pay. But if anyone should be fired or take paycuts, it should be the ones in the c-suite, not physicians.

I mean, significant c-suite salary cuts are happening too. A few major systems have started announcing them this week and I expect more on the way.

And like it or not, the c-suite level admins are kinda important right now as the system moves through crisis management mode.

 

[deleted814217]

View attachment 303175

uhhh huh, real cool and all but if you are gonna make zero effort to try to understand the other side, why even bother?

 

[yeasports]

uhhh huh, real cool and all but if you are gonna make zero effort to try to understand the other side, why even bother?

What do you propose? If it is hazard pay then: Why (important as would hot-zone get more, working more hours get more etc)? How much? How often? Who will pay this?

If it is something else you propose state it so we can discuss. You may not like the answers and that is ok, but remember these guys responding to you with more that 20k messages may have some wisdom you could learn from.

 

[qwerty89]

Keep in mind resident pay is already equal across all specialties. As a non-NYC rads resident I've probably reached a lifetime peak in terms of income to work ratio the past month...

Also, how should residents be paid? Clearly neurosurgery residents provide a highly reimbursed service and work a ton of hours yet they make the same income per PGY as every other resident in the hospital. Is that fair?

Should it be based on how much subjective work someone does? Should it be based on the $$$ value they provide to the hospital/clinic?

If its the former then you could argue a rads resident at the chill programs deserves less pay since they peace out at 5pm at the latest as an R1. On the other hand if its the latter, then a PGY-5 rads resident covering nights as the solo in-house radiologist is providing tremendous value (its really hard to keep good overnight radiologists).

 

[NITRAS]

But residents provide no money to the hospital. All resident notes/procedures have to be staffed to be billed. I expect if they pulled in $$ by themselves, then there would be higher variance in compensation.

 

[CopaceticOne]

But residents provide no money to the hospital. All resident notes/procedures have to be staffed to be billed. I expect if they pulled in $$ by themselves, then there would be higher variance in compensation.

LOL, anesthesia residents absolutely make people money.

 

[qwerty89]

But residents provide no money to the hospital. All resident notes/procedures have to be staffed to be billed. I expect if they pulled in $$ by themselves, then there would be higher variance in compensation.

That is a very simplistic way to look at it.

If you have in house internal medicine residents to take admissions and "put out fires" that may reduce the need for employ an additional nocturnist for example. I.E. a big hospital can employ a single nocturnist along with an on call senior and junior residents instead of having to have a second nocturnist in house overnight. You could try to throw the additional work on the first nocturnist but that just makes it that much harder to hire and retain them.

A senior radiology resident who is in house dictating cases provides tremendous value. Someone needs to be available to dictate cases and answer questions (of which there are many). Either you pay a teleradiology service like vRad to have a board certified radiologist prelim cases for you (which the hospital has to pay for) or you have faculty taking call overnight. Yes faculty are already "on call" overnight but there is a big difference between being "on call" and sleeping through the night and actively dictating cases all night. The faculty can instead stroll on in at 8am with a cup of coffee in hand and sign off on the cases read overnight. Not to mention you need someone to be available for emergent procedures/studies. The resident can help perform a retrograde urethrogram for the 2am level 1 trauma or do the fluoro esophagram to rule out perforation at 3am.

Senior ortho residents can stay in house and see those ER trauma patients, cast them, and have them follow up in clinic. Either that or you pay an ortho NP/PA 2-3x the money to do that. Those guys get paid 100-150k a year for 9-5 M-F daytime work. How much is it going to cost to get them to cover call for you?

I can go on and on.

 

[AMEHigh]

Fine.

Are the janitors getting hazard pay? The food service people? Maintenance?

Yes. I know one large hospital system here has announced they're giving everyone a bonus for hazard pay that's been working, this includes environmental services, maintenance etc.
Not sure how many others have been doing the same.

 

[Modstopizdy]

I'm an attending in the face of a pandemic. I'm likely to see a salary CUT due to decreased volumes/surgeries related to this. I am NOT getting hazard pay even though I still have chances of coming in contact with positive patients on a regular basis.

So, no, I don't have much sympathy for residents complaining about their salary or hazard pay. Everyone is being affected here.

If you spent some of the energy you're using to criticize residents for fighting for their interests to instead fight for your own interests, maybe you would be getting hazard pay just like the nurses and midlevels are getting. But no, instead you are taking to the nets to argue we should all just be happy to get butthumped. The physician in a nutshell, and people are wondering why the profession is going to the dogs lmao. With allies like this who needs enemies.

 

[Modstopizdy]

But residents provide no money to the hospital. All resident notes/procedures have to be staffed to be billed. I expect if they pulled in $$ by themselves, then there would be higher variance in compensation.

Laughable nonsense. Residents are paid from federal GME funding. Not only that, but the GME funding per resident is greater than the resident's salary. We're not only free labor for the institution that "employs" us, the institution actually gets paid to allow us to perform free work for them. It just absolutely sickens me that instead of fighting for their own interests like every single other goddam profession, people in this field will go to any length including outright lies and fabrications in order to sabotage themselves and their colleagues. It's like some kind of disgusting masochistic fetish, I truly cannot find any other logical explanation for it.

 

[CopaceticOne]

Our institution's entire medical staff, EXCEPT for residents and fellows, are having their pay CUT right now. Yes, this includes the ICU docs & hospitalists managing COVID patients. And a non-trivial number of support staff have been furloughed. I think people need to have a bit more perspective and selfawareness at this point.

Any trainees lining up to participate in these pay cuts? Trainees in specialties that have had a significant decrease in patient volumes/experiences willing to be furloughed?

*only hears crickets*

 

[VA Hopeful Dr]

Laughable nonsense. Residents are paid from federal GME funding. Not only that, but the GME funding per resident is greater than the resident's salary. We're not only free labor for the institution that "employs" us, the institution actually gets paid to allow us to perform free work for them. It just absolutely sickens me that instead of fighting for their own interests like every single other goddam profession, people in this field will go to any length including outright lies and fabrications in order to sabotage themselves and their colleagues. It's like some kind of disgusting masochistic fetish, I truly cannot find any other logical explanation for it.

That's not entirely accurate.

First, the GME funding has to cover salary, benefits, non-clinical support staff, and non-clinical time for clinical staff. Let's not forget electives where you get paid but don't actually produce anything. Our local IM PD here on SDN has posted on this extensively. For IM, interns lose the hospital money, PGY-2s at some point during the year start breaking even, and PGY-3s earn money. So no, residents aren't free labor for the hospital.

Second, physicians fight for our own interests all the time. Residents, for most of us, just aren't a high priority. Why should they be? Its a finite time period before going on to much MUCH better things. Where would you rather I spend my time: lobbying at the Statehouse to prevent NP independent practice or lobbying the local hospital to pay the residents more?

Third, I have no idea where in your career you are but this passion can be used to great effect and I hope you do so when you're in a position to. But let's not throw around needless insults. It cheapens good points you could be making.

 

[ThoracicGuy]

If you spent some of the energy you're using to criticize residents for fighting for their interests to instead fight for your own interests, maybe you would be getting hazard pay just like the nurses and midlevels are getting. But no, instead you are taking to the nets to argue we should all just be happy to get butthumped. The physician in a nutshell, and people are wondering why the profession is going to the dogs lmao. With allies like this who needs enemies.

 

[operaman]

Ok current resident here with a slightly different take on this stuff.

1) I am strongly against hazard pay for residents. Not that I wouldn’t mind some extra cash, but the very notion of hazard pay is that it absolves the institution of their responsibility- their duty - to provide a safe working environment. I would prefer institutions protect their trainees with proper PPE or, if not available, with policies that keep them out of harms way. They are a uniquely vulnerable population and their attendings should do their best to protect them.

2) I do think there are good reasons to provide additional compensation to some residents. Trainee compensation is actually very good, especially when you account for the free tuition for all the education you are receiving. Unfortunately, covid has pulled some residents to assignments with minimal to no educational value. Residency is always a balance of service and education, and there are some places where those scales have tipped entirely toward service without much education at all. For those residents it would be reasonable to offer them an additional stipend to acknowledge both their work and the fact their education has been put largely on hold. Yes you can learn some things from covid but in the worst hit places it’s surely more of a meat grinder at this point.

3) the most disturbing part of that Twitter rant were the internal emails that got leaked. When you’ve got the chief of GI asking to see if any of his fellows signed the petition, or their chair of urology trying to impugn the residents’ professionalism for even asking, then that represents an abject failure of leadership and betrays what is likely a terrible culture. You can’t lead effectively if you don’t have the trust of your people, and NYU’s leadership have lost it.

Then the nail in the coffin not even in that thread was a small piece in the NYU student newspaper. The article itself wasn’t novel, but then nearly every physician leader at NYU wrote blistering letters to the editor blasting the writer. Such a campaign could only come at the direct order of senior leadership which again shows how poorly led they are. And then you have all the anon comments from residents pointing out the lies in the attendings’ letters - it’s a mess!

 

[VA Hopeful Dr]

Ok current resident here with a slightly different take on this stuff.

1) I am strongly against hazard pay for residents. Not that I wouldn’t mind some extra cash, but the very notion of hazard pay is that it absolves the institution of their responsibility- their duty - to provide a safe working environment. I would prefer institutions protect their trainees with proper PPE or, if not available, with policies that keep them out of harms way. They are a uniquely vulnerable population and their attendings should do their best to protect them.

2) I do think there are good reasons to provide additional compensation to some residents. Trainee compensation is actually very good, especially when you account for the free tuition for all the education you are receiving. Unfortunately, covid has pulled some residents to assignments with minimal to no educational value. Residency is always a balance of service and education, and there are some places where those scales have tipped entirely toward service without much education at all. For those residents it would be reasonable to offer them an additional stipend to acknowledge both their work and the fact their education has been put largely on hold. Yes you can learn some things from covid but in the worst hit places it’s surely more of a meat grinder at this point.

3) the most disturbing part of that Twitter rant were the internal emails that got leaked. When you’ve got the chief of GI asking to see if any of his fellows signed the petition, or their chair of urology trying to impugn the residents’ professionalism for even asking, then that represents an abject failure of leadership and betrays what is likely a terrible culture. You can’t lead effectively if you don’t have the trust of your people, and NYU’s leadership have lost it.

Then the nail in the coffin not even in that thread was a small piece in the NYU student newspaper. The article itself wasn’t novel, but then nearly every physician leader at NYU wrote blistering letters to the editor blasting the writer. Such a campaign could only come at the direct order of senior leadership which again shows how poorly led they are. And then you have all the anon comments from residents pointing out the lies in the attendings’ letters - it’s a mess!

Yeah the way the higher ups responded to this was just awful. I get that they were mad, but still.

 

[<L>]

3) the most disturbing part of that Twitter rant were the internal emails that got leaked. When you’ve got the chief of GI asking to see if any of his fellows signed the petition, or their chair of urology trying to impugn the residents’ professionalism for even asking, then that represents an abject failure of leadership and betrays what is likely a terrible culture. You can’t lead effectively if you don’t have the trust of your people, and NYU’s leadership have lost it.

Then the nail in the coffin not even in that thread was a small piece in the NYU student newspaper. The article itself wasn’t novel, but then nearly every physician leader at NYU wrote blistering letters to the editor blasting the writer. Such a campaign could only come at the direct order of senior leadership which again shows how poorly led they are. And then you have all the anon comments from residents pointing out the lies in the attendings’ letters - it’s a mess!

Does anyone have a link to the NYU paper? Because I have to be honest, I can't even really get mad at those internal emails. The assumption that "OMG the PD is collecting a list of names for retaliation!!" is jumping the gun here. The initial email was about wanting to sit down and talk to the residents about their concerns. The NYU GI PD asking to see if he needs to do that with any of his people is...fine. It's the type of discussion my PD would have to have with residents every so often, and I'd have to have similar "look, I know you're upset about this, but trust me, you don't want the unintended consequences of what you're asking for" talks to younger trainees when I was a chief resident too.

And quite frankly, if the response is "I'm going to go on twitter and put my program on blast", the insinuation about the maturity and professionalism isn't unreasonable.

edit: Looks like what you were referring to got pulled?

Statement From Washington Square News - Washington Square News

WSN has retracted an article, “NYU Must Compensate Its Medical Workers Fairly,” which was published by our Opinion Desk on April 17, 2020 and has received a substantial response from the community. I would like to take this opportunity to address some of the criticism the piece has faced as well...

nyunews.com

 

[operaman]

Does anyone have a link to the NYU paper? Because I have to be honest, I can't even really get mad at those internal emails. The assumption that "OMG the PD is collecting a list of names for retaliation!!" is jumping the gun here. The initial email was about wanting to sit down and talk to the residents about their concerns. The NYU GI PD asking to see if he needs to do that with any of his people is...fine. It's the type of discussion my PD would have to have with residents every so often, and I'd have to have similar "look, I know you're upset about this, but trust me, you don't want the unintended consequences of what you're asking for" talks to younger trainees when I was a chief resident too.

And quite frankly, if the response is "I'm going to go on twitter and put my program on blast", the insinuation about the maturity and professionalism isn't unreasonable.

edit: Looks like what you were referring to got pulled?

Statement From Washington Square News - Washington Square News

WSN has retracted an article, “NYU Must Compensate Its Medical Workers Fairly,” which was published by our Opinion Desk on April 17, 2020 and has received a substantial response from the community. I would like to take this opportunity to address some of the criticism the piece has faced as well...

nyunews.com

Good point - I may be judging the internal emails too harshly on the surface, and clearly I’m not privy to all the other discussions there that surrounded them. I am probably extrapolating based on their very strict media restrictions for trainees combined with the leadership blasting that now-retracted article. Oh and that the same urology chair who blasted his trainees in a public email was also sued by a former partner for some pretty severe allegations of financial impropriety. That doesn’t make the leaked emails malicious, but lots of little pieces of evidence keep coming together to paint a picture.

Here’s the initial letter from Langone himself followed by a rather aggressive comment barrage from senior leaders and anon rebuttals from residents:

Letter to the Editor: “NYU Must Compensate Its Medical Workers Fairly” - Washington Square News

It is deeply disappointing that an “opinion piece” by one of your own editors was allowed to publish despite numerous factual inaccuracies. Of greatest concern is that the piece makes erroneous and unsubstantiated claims that were not fact checked with reliable sources. Most disturbing are...

nyunews.com

And then this one aggregating those comments and other letters:

Letters to the Editor: “NYU Must Compensate Its Medical Workers Fairly” - Washington Square News

Editor’s Note: The following article contains all the Letters to the Editor that the aforementioned article has received. For the sake of transparency, we will update this article if we receive additional Letters to the Editor for this piece. For the sake of concision and consistency, we have...

nyunews.com